TB-PH-SS-4 HEAITK INSURANCE (Kenko Hoken) PUBLIC HEALTH AND WEI FARE TECHNICAL BUI LET IN PH&W GHQ SCAP no 500 March 1949 1. Introduction - ac This is the second in a series of Technical Bulletins to be issued by Public Health and elfare Section, SCPF, on the Japanese social insurance lav/s and ordinances, giving specific information on the administration of such laws, and providing suggested guide sheets for the convenience of the Military Government Teams0 The first of the series, issued in December 194-8, concerned National Health Insurance0 ba Attahced Inclosure #1 is an English translation of the Health Insur- ance Law, Inclosure #2 is a copy of Enforcement Regulations prescribed by Cabinet Order and Inclosure Jf3> is a suggested guide sheet for use in reviewing the administration of society-managed health insurance in a prefecture0 An English translation of Enforcement Regulations and forms prescribed by Ministerial Ordinance is now being prepared and will be released at a later date a Guide sheets for reviewing government-managed health insurance will be incorporated in a subsequent Technical Bulletin concerning the operations of prefectural insurance sections and the social insurance branch offices* 2, Summary of Program - a• General Scone; Health Insurance in Japan is an integral part of the Japanese social insurances which have been in effect for a number of years. It applies chiefly to industrial, commercial, mining, and transportation workers and provides benefits for medical and allied care arising from non-occupational causes. It may also apply to the employees of a government office or juridical person or to employees of an employer not otherwise covered who t ith the consent of one-half or more of his employees elects to have such insurance. It is effected and controlled by the Health Insurance Law of 1922 (effected in 1927) and subsequent admendments thereto, rnd is compulsory for all regular full- time employees in the respective categories of employment in establishments or offices of five or more employees. It is financed in the main by monthly contributions from employers and employees, based with limitations on the amount of wages paid hnd receive.d. Latest amendments to the Law wore made in July and December, 194-8 « New appeal, penalty, coverage, and administrative provisions were added in July, and under the amendments, coverage, as of April 1, 194-9, will bo ex- tended to Japanese workers employed by the Japanese Government for the Occupation Forces,, In December a single amendment was made which increased the limit of the standard remuneration of an insured person from a maximum class scale of 8,100 Yen monthly, as the highest amount subject to contri- bution, to 13,800 Yen monthlyc The lowest class scale remained unchanged at 300 Yen monthly,, The primary responsibility for the administration of the Health Insurance Law is vested in the Ministry)of Welfare, with provision for two distinct types of management; namely; government-managed health insur- ance and society-managed health insurance. The basic differences in these types of management, which will be treated in subsequent paragraphs, is that government-managed health insurance usually applies to employees in establishments or working places which employ loss than 500 workers and is under full government control while society-managed, which may be effected in establishment of 300 or more workers, is chiefly under the con- trol of the society concernedc b» Benefits; Benefits under the Law/ for insured members cover medical and dental services and cash allowances for sickness and injury arising from non-occupational causes; medical services and cash allowances for maternity, delivery, nursing, and funeral expense; and cash repayments for amounts ex- pended by the insured for services,. The amount of cash allowances paid during periods of sickness or incapacity varies according to the standard monthly remuneration of the insured„ The amount of cash benefit for re- payment of medical service costs, expended by an insured for service from a private doctor, is determined by prescribed rates* The same type of benefits, excluding cash allowances, arc provided for the dependent of an insured member; however, the insurer will allow/ to the insured member only 50% of the cost of such dependent's benefits at prescribed rates and the insured member must pay the balance of such cost, c. Financing: Employee contributions in government-managed health insurance are limited by the law to a maximum of 2<,2% of their standard monthly remuneration and in the society-managcd typo to 2*5%« An employer's contribution each month must equal his employee contributions, but the employer is not prohibited from making additional contributions if he so desires* Other income available for health insurance activities may arise from donations, fees for service to non-insured persons, investments, 2 and from limited government subsidies. Employee contributions are collected through payroll deductions in both types of management and it is the res- ponsibility of the employer concerned to make such deductions„ d, Government-managements The government-managed type of health insurance is for persons em- ployed in establishments having 5 or more but less than 500 workers however, an establishment of 300 or more employees may be granted authority to operate a health insurance program. This authority demands that such smaller establishments have the proper facilities for carrying on an ade- quate program, and in actual practice establishments that employ over 500 workers may remain under government-management for a considerable period before a society-managed plan is approved,. In the government-managed type the government is the insurer and conducts its business through the Insurance Section of the Profectural Welfare Department, In these operations contributions are sent by the employer to the National Government through the Prefecture! Insurance Section and appropriations for the payment of benefits, medical care claims, and business operational costs arc forwarded by the National Government to the Profectural Insurance Section for disbursement„ In a prefecture, where conditions warrant, a branch office of the Profectural Insurance Section may be established to permit more efficient and convenient operations of the programc Medical facilities used in the government-managed type may bo owned by the Ministry of Welfare, privately owned pnd under contract to the government, or privately owned and made available for insured members# The insured members receive medical service from arpointed or private doctors, or from staff doctors of the government owned or operated facilities, upon presenting valid membership certificates issued by the Profectural Insurance Section through the employers to the insured members. The certificates arc prepared from employee listings supplied to the'Insurance Section by the employers concerned. Statements from insurance doctors for services rendered to insured members and their dependents were formerly paid by the Insurance Section but are new to be paid by the branch office of the Medical Fee Payment Fund established in the area * Services obtained from other than insurance doctors by insured members are payable by the insured members with subsequent reimbursement by the Insurance Section, according to amounts allowed by the Law, The services available under the government-managed typo to the insured members and their dependents are specified in the Lawc e , S o c i e t y-ma na go me nt : The society-managed type is primarily for single establishments or a combination thereof which regularly employ 500 or more workers. An estab- lishment that employs 300 to 500 workers may, with the approval of govern- ment officials, voluntarily form a health insurance society and administer its own health insurance program* For an establishment that regularly employs 500 or more full-time workers it is obligatory th°t such concern organize and operate a health insurance society for its employees, although such operation may be deferred by governmental action and the employees re- main under government-managed insurance until a society can be.properly formed* In the society-managed type the policies and administration of the society are determined and directed by a society council and a board of directors* These guiding bodies are formed by members of the society with equal representation for management and ¥;orkers0 Thus it is to a marked degree autonomous * The society council is composed of a fixed number of councillors, with a two year term of office, and is so organized that it contains half of its councillors appointed by the employer and half elected by the workers* The fixed number of councillors is deter- mined by the society concerned. In a similar manner the board of directors of the society is composed of a fixed number of directors half of which are elected by the councillors representing employer interests and half by councillors representing worker interests* The authority of the board of directors is usually limited to administrative matters but may, under certain circumstances, extend to councillor duties, especially when a new council is being formed or when a council is not in session* In the society-managed type the society acts as the insurer and conducts all necessary business to effect a health insurance program for its members* Its operations, however, are subject to the approval of government officials and its affairs and records arc subject to periodic inspection and audit* It must submit regular monthly and annual reports to proper government offices* Medical facilities of the societies are usually owned and operated by the employers concerned and the society is charged for the usage* It is possible, however, for a society to own and operate its own facilities and to extend to non-insured persons in the community such services as it may bo able to provide* In addition to the medical service personnel that may be employed on a full-time basis by a society, insurance doctors appointed upon their own request by the prefectural governor are avnil°ble to the insured members, or the members may obtain the services of a private doctor* The benefits provided by the societies are as stipulated in the Law and in addition they may be augumented by other services if the society so elects and has the resources to furnish such additional services* f, Rights ef Interested Parties: The law provides all interested parties adequate rights of appeal through an insurance referee in each prefecture and further appeal or mediation through a Health Insurance Appeals Board established at the national level. Appeals may be made on the assessment or payment of contributions, the determination and payment of insurance benefits, the ad- ministration of the Law, the formation of official bodies managing the affairs of the health insurance program, and other issues, and mediation may be requested and obtained on controversies between the insured, the insurer, and doctors. Appeals are made initially to the Insurance Referee in the pre- fecture and may be carried higher to the Health Insurance Appeals Board, and thence be made the cause of a lawsuit. Requests for mediation are made through the prefecture! governor to the Health Insurance Appeals Board. The Law further provides penalties for administrative irregularities, abuses, and infringement, lor the protection of interested parties, 3. Current Problems - In general the administration of health insurance is comparatively free of the present reformation difficulties that prevail in the National Health Insurance program; however, economic conditions have caused curtailment in the development of adequate service facilities and created a lack of surveillance by managing personnel. This in turn has caused deliquencies in contributions and a lack of proper accounting and reporting procedures. 4. Major Objectives - Major oc„eo Gives go be attained in reviews of organizations administering health insurance are those thr t rive encouragement to good administrative practices, a-wording to democrat’ c concepts, and place specific accent on the following? a. The *oelection of dwliqv--nt accounts* The t-stabVi.shirr.at, of prom t contribution collections and payments employers c, The svelov-me.nt of good inibrma tional programs for the insured,, d . The „ii ,u cvv.rr. at of wrdicai faciJi tic s and so; vices- o vhc doption of round financial pollute.. :Jt practices. f, .?ho adoption of proiapt and accurate repo:'- leg techniques g Ti■■ e ;'ev<;loumoiit of good jl-'m .rions ■ vj t850 8,550 30th 9,000 300 9,150 8,850 31st 9,300 310 v 9,450 9,150 32 nd 9,600 320 9,750 9,450 33 rd 9,900 330 10,050 9,750 • 34th 10,200 340 . 10,500 ■ 10,050 35th .10 ,'800 36 0 11,100 10,500 36th 11,400 380 11,700 11,100 37th 12,000 400 12,300- 11,700 38th ' 12,600 420 12,900 12,300 39th 13,200 440 13,500 12,900 40th 13,800 4 60 - 13,500 l/ Classes 28 through 10 '-nro r e’do-for the collection of taxes in arrears or may demand such action of the city, or village where the defaulters live or their property lies; ho- ever, When a Health Insurance Society is the insurer, collection1 by-disposal of property, according to the process for -the. collection of taxes in arrears, is allowable only when disposal has been* demanded of the city, town, or village concerned and the letter has failed to institute such action within 30 days from the day of its receiving the demand or when it has failed to complete it within 90 days* Approval by the Welfare Minister is required when a Health Insurance Society’disposes of an property according to the process for the collection of taxes in arrears prescribed in the proviso of the preceding paragraph, * * ■’. When the insurer demands action of a city, town, or village in accor- dance with paragraph 1, the cityy town or village will, make:the disposi- tion in■accordance with the taxation procedure of the city, town, or village. When the city, town, or village concerned makes the collection for the Society, the city, town or village will receive four per cent of the amount collected. The terms "towns" and "villrgos" in pr r grr ph 1 anr1 in the pr3ced- ing paragraph a re -applicrble to those districts not organized cs towns or villa gos * - Articlo 11-3* The prec "donee of contributions ; nd othor assess- ments proscribed in this Lew is second in priority to the assessments of cities, towns, villrgos, or associations of local public bodies 1/ but precedes other public imposts* Articlo 11-4* -ith respect to the deliv ery of documents con- cerning contributions rnd other assessments proscribed in this Law, Articles 4-7 and 4-B of the National Tax Collecting Law shall govern, Articlo 12, When a person is employed by th gov rnmont or is employed by an office of a local public community and is a member of a Mutual Aid Association, in accordance with the National Public Service Mutual Aid Law, ho shall not be entitled to the benefits pro- fided by this Law, The kind rnd degree of benefits of the. said Mutual Aid Associa- tion arc equal to or above the benefits provided by this Law, 2/ Article 12-2, With respect to a Mutual Aid Association, as des-* cribod in the preceding article, the Welfare Minister may require such Association to report operations, issue instructions on the management of the Association, and inspect conditions and property of the Associa- tion, j/ Articlo 12-3, Contributions for Health Insurance shall not be collected from those ineligible for Health Insurance benefits by reason of Article 12, • • ’ Chapter II, Persons Insured, Articlo 13. All persons who arc engaged *in employment in working places (as used throughout this Law includes offices) within the follow- ing categories shall be insured ;under Health Insurance: 1, Working places which regularly employ five or more persons engaged in: i/ Article 2B4 of Local Autonomy Lav/ defines "local public bodies". 2/ Entered in the Japanese text as a notation. i/ Similar provision in Article 9, par; graph 2, NPSMAA Law, - • a) The" manufacture, alteration, splection, packing, .; -repair-, or demolition of. rrticlo-s;. b) Mining, cuarrying, or other processes for the extrac- tion of minerals from .the g: rth; c) The generation, transmission, and supply of electric city and other motive power; . d) ■ The trrnsport of passengers or freight; •o) The- loading .and unloading of freight; f.)- Tho sale and distribution of goods; a g) ■Finance or insurance; ■ : ■ h) Tho storange or loan of goods; ’ • i) .The brokerage of any kind of goods or services; j) Guido servico, advertising, or the collection of moany; k) Incineration, sweeping, or butchery, 2, An office of government or juridical person which regu- larly employes five or more persons, article 13-2, Persons who come under any of the following sub- paragraphs, irrespective- of other provisions of the Law,, shall not bo insured under Health insurance, 1, Persons insured under Seaman's Insurance (excluding those designated in Article 20, p- ragraph 1, of tho Seamen's Insurance Law), 2, Persons employed temporarily} a) Persons employed for not more than the contract period of two full months; b) Persons employed on a daily basis, • .jf, h owe very a person excluded by sub-paragraph (a) is employed continuously beyond the designated ti?ee or if a person excluded by sub-paragraph (b) is.,employed conti~ nuously beyond one month, tho provisions of such sub- paragraphs shall not bo applicable. 3, Persons engaged in seasonal work, excluding persons intended to be employed continuously beyond four months, 4, Persons employed by establishments engaged in temporary, enterprises, excluding persons, Intended to bo employed continuously beyond six months; 5, Persons employed by working places or offices when such working places or offices have no fixed location; 6, Persons employed by a National Health Insurance Associa- tion or by a corporate juridical person administering - ■ National Health Insurance; 7, Persons employed by a life insurance company as solici- tors for life insurance and v/ho receive commissions instead of a fixed amount of remuneration, When a person insured under Health Insurance in accordance with ’the preceding article becomes insured under National Health Insurance, 7/ith tHo approval of the insurer, or with th approval of the Mutual .Aid Association as prose-; ibod in Article 12, such person shall not be insured under Health Insurance during such period, l . Article 1/, Employers engaged in undertakings not designated in Article.13 may apply for the approval of the Welfare Minister to have all of their employes .insured under Health Insurance*. In applying for the approval prescribed in tbo preceding pan graph the consent of one-half or more of all employees of the working place shall be necessary. Article 15. When the approval prescribed in the preceding article it granted, such employees will bo insured under Health Insure nco. The provisions of Article 13-2 shall serve to preclude, approval. Article 16, If a businosf of the type listed in. Article 13 ceases tc ic subject to the provisions of such article it shall be considered rs laving been granted the approval pr-scribed in Article 14, Article 17, Persons insured in accordance with the provisions of Articles 13 or 15, are insured as of the first day of employment or on the day when the provisions of Article 13-2 or Article 15, para- graph 2, become inapplicable to thorn. Article 18. Persons insured in accord? ncc 7/ith the provisions of Articles 13 or 15 arc disqualified as insured on end after the day following the date of doath, sever nco of employment, or when Article 13-2 or Article 15, pert graph 2, becomes applicable to them. However, if the provisions of the preceding article become applicable on the 'date of severance of employment, or when Article 13-2 or Article 15, paragraph 2, b comes applicable to them, they are disqualified as of that day, -1 ’ ’ ' - Article 19, Emplo'/crs of persons insured, according to Article 15 may'apply forJtho approval of the' ,A; If arc linistor to hr vo all such in- sured persons disqualified as insured, • , In applying for the approval proscribed in the preceding paragraph, the' consent of not loss than throe-fourths of the persons insured is necessary. When the approval; pro scribed in paragraph 1 has boon granted the persons insured are disqualified as of tho day following the approval. Article 20, Any insured person disqualified by reason of Article 18 may continue*to ho irisur d providing.ho makes 'application to tho insurer, not later than ten days after the date of disqualification or, in case the, insured person is receiving benefits at tho time of dis- ’ qualification., if. he makes applica tion .not later than ton days after the termination of th,o period in which he is receiving b nefits, provide ing further that such person has boon insured for more than two months prior to the date of;disoualificaiion. However, those insured by Sea- men's Insurance (excluding those' designa ted in Article, 20, paragraph 1, of the Seamen’s Insurance Law) shall be excepted from this rule. An application presented later than-as proscribed.in the preceding paragraph may not be-accepted without proper reason being given by the insured, ' Article 21, If a person, in' accordance with the ’preceding article, comes within the provisions of the following sub-pa-ragraphs ho shall bo disqualifled as of the following day. However, .with respect to, sub- paragraphs A and ,5 ho shall bo disqualified a s :of that day, 1, After the lapse of six'months from .the da-,t*o . he became — insured; : * / . . ■ i ... . •* 2’, In the event of death of the insured; ■ : . 3* If the insured docs not pay the total .contributions within ton.days after tho specified date on which contributions arc * ' due; A, If the insured person becomes insured as provided by- Art ides 13 or 15 of this Law; 5* If the insured becomes insured by Seamen’s Insurance (excluding those designated in nrticle 20 of the Seamen’s Insurance Law). Chapter III, The Insurer, Article 22, An insurer under the Health Insurance La?/ shall be cither the Government or a Health Insurance Society, A Health Insurance Advisory Council shall be established to consi- der important affairs concerning the operation of health insurance by the Government, 4 The members of the Health Insurance Advisory Council shall be appointed by the 7f:ilfr.ro Minister and shall consist of an equal number of those who represent the insured, the employer, and the public interest, In addition to the provisions stipulated in the preceding two paragraphs, other necessary matters concerning the Health Insurance Advisory Council shall be prescribed by Cabinet Order. Article 23. The insurer may provide suitable facilities necessary for the treatment of sickness or injury and the improvement of the health of insured persons and their and shall pay the neces- sary expenses thereof, . Article 23-2, The insurer may allow persons other than the insured and, their dependents to utilize the facilities mentioned in bhe preced- ing article only when such use '.'ill not impr ir the intended function of such facilities. The insurer may demand fees in accordance with Ministerial Ordi- nance from those availaing themselves of these facilities. Article 2A, The Government shall manage Health Insurance for insured persons who arc not members of a Health Insurance Society. " Article 25, A Health Insurance Society shall manage Health In- surance for insured persons who are members of the Society, Article 26, A Health Insura nce Society shall be a juridical persons, Article- 27, A Health Insurance Society- s', -all- be .composed of employ- ers and insured employees, _ Article 28, An employer regularly having 300 or more employees in one or more working places may form a Health Insurance- Society, Two or more employers of insured employees may jointly form a Health Insurance Society, In such case the combined number of insured persons shall regularly number 300, or more. Article 29. The consent of half or more of t1 ose persons to be in- sured who possess the qualifications to-be members of the Society shall be obtained to form a Health Insurance Society, Articles of the Society shall be drawn up and the approval of the Welfare IUnis ter shall be ob- tained ... Whenever a Health Insurance Society is to bo formed that covers two or more, working places the consent prescribed in the preceding paragraph shall be obtained from the employees of each working place. Article 30, The term Hinsured person” in the preceding two- articles shall also include those persons to be insured when application for appro- val of the formation of a Health Insurance Society and-application for the approval prescribed in Article 1A, paragraph 1, are made at the same t imo« Article 31. • The- ‘Welfare minister may order the formation -of a Health Insurance Society by an employ r regularly having 500 or more in- surable employees, as defined in Article 13, in one or more working places. Article 32. The employer who has been ordered to form a Health In- surance Society shall draft art id s-for the Society and obtain the appro- val .of the- Welfare Minister ,f.or the formation of the Society, Article 33. Deleted* Article, 3A. A Health Insurance Society is officially authorized when approval is granted for its formation. „ Article 35. When a Health Insurance Society is formed the employer and all the insured employees , of the working place become its. members.- • Article 36, An amendment to the Articles of a Health Insurance Society does not be com: of. active until such amendment is approved by the ’Welfare Minister, Article 37. The, Wolfr re Minister may require a Health Insurance Society to submit reports on its affairs, inspect the conditions of its business and its funds, order emend me nt of the articles of the Society, and make other necessary changes in the administration of the- Society. Article 37-2, The Welfare Minister may thr ough Ministerial Ordi- nance reouire the install/tion of insur: nee facilities' and the payment of expenses thereof, as prescribed in article 23, Article 38. When the officers of a Health Insurance Society are absent, not available, or in difficulties, or if the Society fails to provide b nefits or perform other duties, the Welfare. Minister may appoint government officials and others to discharge the duties of the Soc iety. In circumstances described in the preceding para.gr/ph the ex- penses necessary for the discharge of such duties shall bo borne by the Health Insurance Society, Article 39. When a determination of b Health Insurance Society or the conduct of an officer is contrary to law, or to the directions of the Welfare Minister, as prescribed by law, or to the Articles of the Society, and it is recognized to bo harmful to the interests of the members of the Society, or when continued existence of the Society is considered to bo difficult in of the condition of the Society's fin/ nees and property, the Welfare Minister may revoke the determination, discharge the officers, or order the dissolution of the Society. Article AO. The assets on' liabilities of a Health Insurance Society which has been dissolved shall be assumed by the Government. Article Al. Matters concerning the administration, partition, amalgamation, or dissolution of a Health Insur? nec Society, the custody and use of the Society's property, and other necessary matters referring to the Health Insurance Society, not provided in this Law, shall be prescribed by Cabinet Order, Article A2, The insurer of a n insured person who is employed by two or more employers at the same time sha 11 be designated by the -Volfart; Minister, article A2-2, Health Insurance Societies may jointly form a Health Insurance Federation to accomplish their mission, A Health Insurance Federation shall bo a juridical person. In establishing a Health Insurance Federation, Articles of the Federation shall be drafted, and approval obtained from the Welfare Minister, ■ The Welfare Minister may order Health Insur- nee Societies to join a Federation when ho deems it necessary for the gon rt.l welfare of the insured. _ •*. < . The provisions of Articles 23, 23-2, 3/, 36 through 39, and 11 shall be applicable to a Her 1th .Insurance Federation, • :-r Chapter IV, Insurance Benefits, Article A3, The following benefits shall be provided... for sickness and injury of the insured person: 1* Medical examination! 2% Supply of medicines and other therapeutical materials; 3, Medical treatment, operation, end other tho-ra political care; A, Hospitalization and clinical service; 5. Nursing; . . \ 1 \ ' ’ . . 1 6, Transportation, ■ . Benefits stated in items A, -5, and 6 of the preceding paragraph shall be granted when considered- necessary by the., insurer or when prescribed* by Ministerial Ordinance, Article A3-2« An insured person desiring to obtain any benefit’ ■ described in the preceding Article, paragraph 1, items 1 through A, will receive-such benefits from an insurance doctor l/ or pharmacist, or person appointed by the insurer according to the insur’d person's choice, article A3-3» .-Insurance doctors and pharma cists shall be appointed by the prefecture 1 governors from among licensed doctors, dentist's, and pharmaclets. An agreement by each doctor, dentist, or pharmacist appointed shall be necessary to effect the appointments stated in the preceding paragraph, . The insurance-doctors or pharmacists who ar appointed according to paragraph 1 of this Article shall ex-- reiso medical c? re and the grant-, ing of medicine in accordance with the requironr ntc of the profectural governor, jl/ "Insurance doctor" as used throughout this translation, means "insurance doctors and insurance dentists" Insurrnco doctors or phr rm? c lets may r sign their positions when they do sire. When an insurance doctor or pharmacist wishes to resign in accord- ance with the preceding paragraph ho shell submit i statement of his resignation one month in advance. Article 13-1.. Insure nee doctors and pharmacists shell exercise kindness and care in dispensing medical care to the insured and to the insured ls dependents,- If insurr nee doctors or pharmacists n gleet their obligations in giving medical-ca re, the prefecture! gov rnor may cancel their appoint- ments, Article 43-5. A Central Social Insur; nco ?redical Care Advisory Council and Local foetal Insurance M fieri advisory Councils shall bo organized to guide end supervise insur; nc ■ doctors and pharmacists for proper social insurance medical care,. The he Iff re Minister shf 11 appoint the members of the Central Social Insurance Medical C; re Advisory Council and .the prefectural governors sha ll f ppoint the members of the Local Socia.l Insurance Medical Caro advisory Councils, The membership of each council shall consist of an equal number of rpros from among the represen- tatives of tho insurer, insured and employers, physicians end dentists, and the public interest. The above 'appointments of persons who are to represent the insured and employers, and physicians and dentists, shall be from among those recommended by the organizations concerned. Article Z3-6, . Tho amount of cost which insurance doctors, pharma- cists, or persons l/ that employ doctors, dentists, or pharmacists, are to charge the insurer for medical cr.ro provided, shall‘equal-the amount determined for such mdicrl care, . Tho medical care claims as submitted to the insurer for medical care provided to tho insured shall be cflculated by tho insurer in accordance with the foe schedule determined by the VJolfare Minister, Tho V/elfare Minister in ma king fee determine tions, according to the provisions of the preceding paragraph, shall consult vthe views of the Social Insurance Medical Fee Calculating Committee, 1/ Persons, juridical persons, organizations., etc., that extend employ- ment to medical personnel. 15 Article 43-7. For the purpose of roeomi&ndltig:prop r nodical care fees for Health Insurance, the Social insurance 'lexical Fee Calculating Committee shall, be established, ... . ., , , The members of thr> said Committee shall bo appointed by the Jelfarc Minister with an equal number of representatives from among representa- tives of the insurer, insured and employer, physician anr dentist, and public interest. In the above appointments the persons who are Vo repres ent the insured and employers, and the physicians and dentists*shall be from among those recommended by the organizations concerned. Article 44. When an insurer cannot provide medical care benefits, or if in time of urgency or owing to urn voidable circumstances it is considered necessary to provide medical care for the insured by doctors, dentists, or others who arc not insurance doctors or persons designated by the insurer, the cost of medical core may bo allowed in pla ce of medical care benefits* Article The amount of cost of medical care that is allowed, according to the provisions of the preceding article, shall bo decided, by the insurer, based upon the amount required for medical c.ro. In applying the provisions of the preceding paragraph, the amount of cost of medical care shall not exceed the a.ctual cost. For the calculation of expenses rocuired for medical care as pre- scribed in paragra ph 1 of. this article, the provisions of paragraphs 2 and 3 of Article 43-6 shall be applied. Article 45# When an insured person is not able to work because he is taking medical care, his daily sickness allowance, beginning with the fourth-day of his incapacity, shall be equal to 60 per cent of his standard daily remuneration. Article 46, Sickness allowances payable to insured persons accomoda- ted in hospitals and clinics, if in the ov nt the insured does not have a family to support, shall be equal to 40 per cent of the insured Ts standard daily*, remuneration. Article 47* The time limit during which sickness allowances are pay- able for the same sickness or injury, or for sickness arising therefrom, shall be six months, beginning with the first day of the incapacity. For special types of sickness, as designated by the Welfare Minister, the insurer may continuously* grant sickness’allowance prescrib' d in the 16 preceding pt rrgrc.ph for t year inf ono he If rfter the slr.pse of the peri or1 of the preceding paragraph. Article /8. Toletod. Article 49, hen an insurer1 person dies, the persons who were supported by him and who perform the funeral rm burial services £ re entitled to a funeral expenses equal to the standard monthly remunera- tion of the deceased. If, however, the said sum is less .than 2,000 Yen, then 2,000 Yon shall bo allowed. 'Then, on the death of an insured person, there is no beneficiary entitled to the funeral expenses, according to the provision of the preceding paragraph, the persons who performed the funeral and burial service will receive a cash payment equal to the funeral expenses or within the limit of tho sum previously mentioned. Article 50. ;7hen an insured person has been confined in bed be- cause of giving birth to a child, she shall be paid an amount for con- finement oqaul to 50 per cent of her standard monthly remuneration. If however the amount is less than 1,000 Yen, then 1,000 Yen. shall paid. When an insured p3rson is incapable of work because of confinement she shall be paid an amount calculated as SO per cent of her standard daily remuneration for a period of 8/ days. Such period will begin 12 days before the day she gives birth to the child. Article 50-2. ”.hen an insured person has given birth to a. baby and she nurses the same baby, she shall be paid 100 yen per month for six months as a nursing allowance. Payments shall be calculated from the day of the birth of the child and a period of less than one canlen- dar month, at the beginning of the period, shall bo calculated as one mont h. The nursing allowance specified in the pr ceding paragraph shall be granted although the insured gives birth to a child within 6 months from tho day of her loss of Qualification, or although the insured loses her qualification while receiving a nursing allowance. Article 51. The insurer may admit insured v/omen into maternity hospitals. Tho amount of r-xp ns ;• which is to be paid to an insured, person who is admitted to a maternity hospital, hospital, or clinic shall be ecual to one-half of the amount which would be paid in accordance with the provisions of Article 50, paragraph 1, eith respect t-> maternity allowance: which is -to; be granted to an insured woman who is ad itted to a maternity hospital, hospital, or clinic, the provisions of Article lo shall be applicable. • - Article 52. Related. Article 53. leleted. ’ . • Article 5/. Turing the period when a maternity allowance is grant- ed a sickness allowance is not payable. Article 55, Insured persons who are disaualified as insured persons during the period in which they ere receiving benefits for sickness, or maternity may continue to receive such benefits from the same insurer for the duration of the term to which such person would have been entitled to benefits had he or she not been disqualified. Article 56, Rhen an insured person dies while receiving benefits according to the provision of the preceding article, or a person previously received benefits according to the provisions .of the preceding article dies within three months after the date on which he ceased to receive benefits, or a person-previously insured dies within three months after the date of his disqualification, the persons who were supported by the deceased and who perform the funeral services are entitled to receive funeral .allowances'from the last insurer of the deceased. The provisions of 'article Z.9 will be applicable with respect to the preceding paragraph when there is no beneficiary to receive the funeral allowance or-the amount to be determined, . ’ Article 57. When the confinement of a woman who was an insured person occurs within six months after date of her disqualification as an insured person, allowances associated with childbirth, - payable to an insured person, shall be payable to her by her last insurer. ■ Article 57-2. Regardless of the provisions of the preceding three articles, persons who have insurance rights under the Seamen1 s Insurance Law shall not be entitled to Health Insurance benefits or allowances. Article 57-3. Benefits and allowances for medical care for the same disease . or innury of an insured, or for a disease resulting therefrom, shall not be paid under the following circumstances: , 1* 7hen the insured is to receive a>n accident annuity or an ac°ideht allowance provided by the Welfare Pension Insurance Law, ' 2, hi hen the insured has not recovered from a disease or injury after receiving medical care for a period of two years. article 58. A sickness and injury or maternity a licence .shall not be paid to persons who suffer from a disease, injury, confinement, or childbirth during e • continuous period y/hen all part;-of their re- muneration is receivable. However, if the amount", of their remuneration which they can receive is less than that . of a sickness $nd injury or maternity allowance, the difference between the amount of remuneration they can-receive and the total amount of the allowance shell :be paid, Article 59. When insured persons, as mentioned in the preceding article, donot receive all'or part of their-remuneration which they are eligible to receive by contract at the time of sickness and injury or maternity, the total amount of the sickness and injury or.maternity allowance, or the difference between the said allowances and remuneratio; received when the remuneration received is less than that of the said allowance, shall be given to them by the insurer; When an insured parson receives a part of the said allowance, in accordance with the provisions of the preceding article, such amount of thewallowanee shall 1. be omitted' from the balance payable to the insured . '• The sum .paid by the . insurer in .accordr nco with the provisions of the 'preceding'paragraph shall be collected from the employer.of the insured person. . ' article 59-2. When a dependent of an insured person has receive £ medical care from a doctor chosen by the dependent from amoung insur_ ' ance dcotors, pharmacists,, or persons designated by the insurer, the ; -amount for dependents medics 1 care expenses necessary for the medical care shall be paid to the insured. An amount erual. to 50 per cent of necessary for medi- - cal care may be allowed as dependent’s medical care ’ expenses-, provided that suvih amount allowed, is not more than 50 per cent of the actual amount pc.id. ' _ . ■ • ' When dependents of an insured .person have received medical care from an"insurance doctor, pharmacist, or person d-esigneted by the . -insurer; within the-limit of the fixed sum to.be paid to the insured, the.insurer may pay the expenses necessary for the medical care expenses to the insurance doctor,, pharma cist, .or .other, designated person instead of to the insured. • “hen the expenses necessary for medical care have been* paid to insurance rectors, pharma.ci.sts, or persons designated by the insurer °r to persons who employ them, in accordance with the'provisions of the ■ preceding pa r* gra ph, the dependent ’s, medical care expenses 1thin the limit of the actual amount pair shall be deemed as having been pair" to the insured. The provisions of Articles 43 and 43-2; Article 43-6, graphs’ 2 and 3; and Articles 44, LI-2, 55, and 57-3 shall be applicable, to depen- dents medical care expenses. • Article 59-3. "/hen a dependent of an insured person, dies the in- sured shall be paid funeral expenses of 1,000 yen. Article 59-4. Y/hen the wife of an insured person gives birth to a baby, the insured person shall be granted 500 yen as the expenses of childbirth. When the preceding paragraph is applicable, a nursing allowance shall be granted to the insured, providing the mother nurses the-child.. When a nursing allowance as specified in the preceding paragraph is granted the provisions of Article 50-2, paragraph 1, shall be applicable. Article 59-5. Notwithstanding the provisions of Article 59-2, para- graph 1, an insurer may entrust the matter of the payment of dependent’s treatment expenses to a city, town, or village; to a National Health Insurance Association; or to a corporate juridical person, providing such entities undertake the functions of administering National Health Insur- ance (hereinafter referred to as "those who exercise National Health Insurance”), In such cases the insurer shall pay the necessary expenses to those who exercise National Health Insurance, With respect to the payment of dependent’s medical care expenses to the insured by those who exercise National Health Insurance, such agents, are given authority to act for the insurer in accordance with the pro- visions of the preceding paragraph, and the provisions of Article 59-2, paragraph 3, shall be applicable. Article 60. Insured persons and persons rreviously insured will not be granted benefits when cause for benefits is brought about intentional- ly or is attributable to intentional criminal acts of the insured. Article 6l. Full or partial benefits not be granted when the cause for benefits arises through an insured's fighting, intoxication, or extreme profligacy. Article 62, Insured persons and those who were previously insured shall not be granted benefits for sickness and injury or maternity when subject to any one of the following conditions: 1J When outside Japanese territory* , - . ... 2. When sent to a.h-Qusc- .of correction 'or; to such other institution* • ■ ■ ’, ; * ::W. •: ..- • V . t , .■ -e V ■; e . , ■ : ' • 3. When imprisoned or detained in jail., police cell, or work-house • When in accordance with the regulations of other laws, medical benefits or medical allowances are granted to persons at a cost of the Treasury or public corporation, medical benefits under this. Lev; shall cease to be granted* The provisions of Article 46 end Article 51, paragraph 2, ere appli- cable to persons subject to the provisions of the preceding paragraph. When any of the conditions in paragraph 1 of this article ere appli- cable to insured persons, or to those previously insured, the insurer is not precluded from granting the dependents the benefits mentioned in the latter part of Article 1, paragraph 1, Article 63, A part of the benefits granted may be withheld when medical orders are disobeyed without good reason# Article 64* When an insured person has received or tried to obtain insurance benefits by fraud or other dishonest method, e decision can be mf.de by the insurer to deny the payment of all or part of the sickness and injury allowance or maternity allowance rcyabl- for a.period of six months; however, this decision cannot be made after a lapse of one year. ’ Article 65. When deemed necessary the insurer may have persons ■ receiving benefits undergo a medical examination. The'total or part of the benefits may bo withheld from'those who without good reason refuse to undergo a medical examination. ' ; ■■ Article 66, .ledical care expenses, sickness and injury allowances, maternity allowances, funeral expenses, delivery expenses, dependent's medical care expenses, dependent's funeral expenses, spouce delivery expense;, and nursing allowances shall be paid • on all occasions when beneficiaries arc eligible, and the funeral expenses, mentioned in Article 49, paragraph 2, or in Article 56, paragraph 2, shall also be subject to this rule. ■' Notwithstanding the provisions! of the preceding paragraph, \a sick- ness and injury allowance, maternity allowance, and nursing alloVrnCG may bo paid monthly on a fixer’ da to determined by the insurer. Article 67. when an insurer has granted benefits in a case where ' the cause of the benefit condition was attributable to a third party, the insurer acquires the right to demand the damages which the insured person or those previously insured possess against the third party,' according to the limit of the benefit sum. Article .68. The right to receive benefits may not be transferred nor seized. Article 69. Taxes and other p’ blic imposts shall not be imposed on the cash and other articles received as benefits. Article 69-2. The provisions of Articles 60; 62, paragraph 1 and 2; 65; and 67 are applicable to dependents. Article 69-3, When the insurer is a Health Insurance Society other benefits besides those stipulated in this Law may be granted according to the .provisions of the Articles of the Society. Chapter V. Expense Charges. Article 70, The National Treasury shall pay the necessary adminis- trative expenses for Health-"Insurance and the amount shall be fixed by the National annual budget. Article 70-2, The administrative expenses of a, Health Insurance Society which are to be paid by government subsidy shall be computed by the Welfare Minister, ca lculated on the basis of the number of insured persons in the Society, The government subsidy mentioned in the preceding paragraph may be roughly estimated and allocated to the Societies, Article 71. Contributions arc.charged to the expenses of Health Insurance, The monthly contribution of the insured shall be calculated as the product of the insurer's standard monthly remuneration and contribution rate. Regardless of the provision of the preceding paragraph, contribu- tions will not be calculated on a continuously insured person 1/ for the month in which the person was disqualified-. 1/ A person who was insured during the month preceding the month in which disqualification occurred, (A person who establishes qualification during the month of disqualification will be subject to contributions). Article 71-2, The contributions of rn insured person according to the provisions of Article 20 shall be calculated as of the month he is entitled to insurance. With respect to persons subject to the preceding paragraph, the contributions for each succeeding month shall be calculated according to the provisions of the preceding article, . Article 71-3- When an insured person who was insured during the preceding month falls within the purview of Article 62, paragraph 1, items 1, 2, or 3, he shall not be charged contributions during the month in which ho becomes subject and during the following complete months he remains subject to Article 62, paragraph 1, items 1, 2, or 3, and his contributions will begin with the month in which he ceases to be sub- ject to Article 62, paragraph 1, items 1, 2, or 3; however, when a . person falls within the purview of Article 62, paragraph 1, items 1, 2, or 3, in the same month in which he qualifies .without being insured in the preceding month, or when an insured person becomes and ceases to be subject to Article 62, paragraph 1, items 1, ?, or 3> during the same month, such persons shall bo subject to contributions for the month in which they became subject to Article 62, paragraph 1, items 1, 2, or^3- Articlo 71-4«. The contribution rate of Government-managed Health Insurance shall bo 4 percent, except as follows: When there is any shortage in the necessary funds for the payment of the expenses of insurance benefits or the expenses of insurance facilities, or, in case there is a surplus, under the existing con- tribution rate, the Welfare Minister may have the .contribution rate changed within the limits of 3.6 per cent to L./ p*r cent, based upon the opinion of the Health Insurance Advisory Council. The contribution rate of Society-m? nagod Health Insurance shall be decided v/ithin the limit of 3 per cent to B per cent, according to regulations proscribed by Cabinet Order. The decision for and the revision of the contribution rate pre- scribed in the preceding paragraph must be approved by the Welfare Minist-r to bo enforceable. Article 72. Contribution charges are to be shared in eoual parts by insured persons and the emplyers who employ the insured; however, persons insured according to the provisions of Article 20 must bear the entire sum. Article 73. Teleted. Article 74* related, . _ _ , . , Article 75. Boge'rdless of the provisions of Article 72 a Her 1th Insurance Society may, in its Articles'of the Society, increase'the rate of contributions to be borne by the employers. Article 75-2• * ‘ The amount of contributions borne per month by insured persons of a Health Insurance Society shall not exceed 2,*5 per cent of their monthly‘standard 'remuneration, and. in case one-haIf of the total employer and employee contributions charged by the insurer exceeds 2.5 per-cent of the insured fs remuneration the employer shall pay the excess. • " • • ♦ • - Article 76, Deleted. Article 77. .Employers are responsible for-the payment to the insurer of their own contributions and the Contributions to be borne by * their insured employees;, however, such provision does not apply to the contri- • buttons of persons insured according to the provisions of Article 20, Regardless of-the; provisions of the- preceding paragraph' an employ- er, in case the insured ceases to be an employee, may at time of settle- ment of insured's remuneration, deduct the contributions to be borne by the insured for the preceding and current months. The employer, when ho deduct a contributions; as provided in -the preceding two paragraphs, shall make,a statement of the deduction and shall notify the insured as t,o the amount deducted. Article 79% The contributions to bo paid to an insurer for a specific month shall be paid by the-end of the following month. When an insurer discovers that contributions have been-charged' or paid in excess of the amount due because of an overcharge by the insurer or because- of an overpayment by the contributor, the insurer shall cre- dit within six months the amount of the overcharge or overpayment to contributions becoming duo from such contributor within'the said six months. According to the preceding provision, if it is regarded that the date of payment was advanced and the: notic3 of payment has been made or paid, the insurer shall notify the contributor concerned. * "' Article 79-2. When a contributor who is to pay contributions becomes subject to any of the following conditions or circumstances, the contributions may be collected before the due date. 1, When a-n action pertaining to deliquericy for national' tax, local tax, or other public levies has been insti- tuted * ... ,2. When the office where the insured has been employed is being abolished* 3. When, compulsory seizure is effected, L „ When adjudged insolvent. 5. When a closing auction is-to be' held, 6, When a juridical person is to dissolve a business where the insured has been enplpyed, " - ... 7 . Chapter VI. Appeals and Lawsuits, * ’ . Article 80. Any person who dissatisfied with the determination of the insurance benefit may appeal to the Insurance Referee, and if ‘ the person mentioned above is dissatisfied with the decision of the Referee, he may appeal the case to the Health Insurance Appeals Board and if dissatisfied with the decision of said. Board, he may bring a suit to the court, * . As to the interruption of the statute of prescription by the appeal prescribed in the preceding paragraph, it, shall be'regarded the same as a request for a law-suit* Article 80-2. Deleted. Article 81. Any person who is dissatisfied with the amount of con- tributions or other assessments levied under this Law, with the action, taken in collecting such amounts, or with the- procedure as provided in Article 11-2 of this Law, may appeal to the . Health Insurance Appeals Board* Article 31-2. . The D'elfero .Minister shall appoint an Insurance Referee in each prefecture and, phall choose them from local officials, who are secretaries 2nd class, . ■ Article 82, The Health Insurance Appeals Board shall be established in the Welfare Ministry, •' 'r Article 83* -The'-Health Insurance Appeals Board shall consist of 3 persons representing the insured persons, 3 persons representing the employers, end 3 persons, representing the public interest and each member shall be appointed by the welfare Minister. Article 83-2, The term of office of members of the Health Insur- ance Appeals Board shall be 3 years, and one third of the members shall be appointed annually, A person appointed to fill a Board vacancy shall complete the term of office of his predecessor. Article 83-3. There shall be a chairman of the Health Insurance Appeals Board elected by the members from among those members who re- present the public interest. In case of the chairman’s absence, an acting chariman shall be elected in the manner prescribed in the preceding paragraph.. Article 83-/. The Health Insurance Appeals Board shall not commence proceedings or make a decision without the presence of at least one member representing the insured persons, one member representing the em- ployers, and one member representing the public interest. Article 83-5. A decision of the Health Insurance Appeals Board on any case shall be made by a majority of those present. In case of a tie the chairman shall make the decision. Article 83-6. Any person who is dissatisfied with a decision with regard to payment of benefits and wishes to appeal shall do so to the Insurance Referee who is competent of the jurisdiction of the prefectual governor who made the decision or of the arcs where the office of the Health Insurance Society which made the decision exists. The appeal mentioned above may be made through the prefectural governor who made the decision or the Health Insurance Society which made the decision with regard to the payment of benefits or through the ■ prefectural governor or the Insurance Referee who are competent of the residence of the claimant, ?Jhen it is found that the appeal, in accordance with the preceding paragraph, belongs to the district of a different jurisdictional'area, the Insurance Referee shall transfer the appeal to the prorer district and shall notify the applicant to that effect. Article 83-7. An appeal to an Insurance Referee or to the Health Insurance Appeals Board may bo made either in writing or orally. Article 83-8, The Insur? nee Referee and the Health' InsuranceAppeals Board shall hold a hearing promptly after receiving an appeal. In case, however, it is difficult for the claimant to attend the hearing the Insurance Referee and the Health Insurance Appeals Board may hold a hearing on the basis of written statements in.lieu .of said procedure, - .. .Article 83-9. y Article 83-10. The person responsible for the award of insurance benefits, the employer, the claimant, and other interested parties and witnesses may express their opinions or submit documentary evidence to the Insurance Referee or-the Health Insurance Appeals'Boprd, In case the claimant considers,it necessary, he may bring an advisor to attend the hearing with him. ■ ;- In.case any interested cannot attend the hearing he may-.authorize a representative to attend in his place. * ' .* V . . ' ' , * . Article 83-11* In case a certain limited portion of the case has been settled, the•Insurance Referee or the- Health■Insurance Appeals Board may make the decision respecting that part first. . . Article 83-12. The decisions of the Insurance .teferee and the Health Insurance Appeals Board shall be in written form with explanations. Article 83-13* If the applicant dies before conclusion'of-the case the right of appeal shall be■transferred to his successor, . • Article 84, Deleted, ’ * Article 84-2, For. the purpose of a law-suit regarding a decision made by a Health insurance Society with respect to the matters referred to in Articles 8p and 81, the said Society shall be regarded as a government office. • • Article 85, No insurance Referee, member of the Health Insurance Appeals Board, "or person who is working or has .worked for the Health Insur- ance Appeals Board shall disclose a secret which he learned while perform- ing his duty. Article 86. An appe-al shall be made or a law-suit instituted within 60 days from the date of receiving a written decision, provided, that with respect to an appeal this time limit may. be extended for good cause as determined by the Insurance Referee or the Health Insurance Appeals Board, as appropriate, With respect to the institution of a law-suit as prescribed in the preceding paragraph, Article 158, paragraph 2, and Article 159 of the Code of Civil Procedures shall be applicable. Article 86-2. Hatters of an administrative nature concerning the Insurance Referee and the Health Insurance appeals Board may be provided for by Cabinet Order. Chapter VII, Penal Regulations. Article 87. The competent official, government official, or persons who were formerly in that capacity, on revealing without reason, the occu- pational and private secrets of doctors or dentists accuired through the inspection of medical care records, in accordance with the provisions of Article 9-2, shall be subject to a sentence of not more than 6 months of penal servitude or a fine of not .more than 5,000 Yen, Other officials or those formerly in office, on revealing, without reason, secrets mentioned in the preceding paragraph, acquired through the execution of official duties, shall be subject to the.same prison sentence and fine as stipulated in the preceding paragraph. lectors, dentists, or those employing them that hinder, refuse, or evade an inspection by authorized officials, according to the provisions of Article 9-2, shall be subject to a fine of not more than 5,000 Yen, Any person subject to the provisions of Article 9 who refuses to answer to the authorized official in accordance with the provisions of Article 9, or on giving false answer or on hindering, refusing, or evading'the official inspection without sufficient reason, shall be sub- ject to a fine of not more than 10,000 Yen for an employer and 5,000 Yen for persons receiving benefits or other, relative persons except employers. Article 88. Employers refusing to present documents or giving false reports,without reason, or disobeying the requests of the insurer, made according to the provisions of Article 8, shall be subject to a fine of not more than 10,000 Yen. Article 83-2. Persons who ere entitled to receive benefits who, without reason, violate the provisions of an order issued in conformity with the provisions of Article 8-2, neglect to make notification or report, or make false notification or report, or neglect to present documents, or make a false record in documents, shall be subject to a fine of not more than 5,000 Yen. Articles 88-3. Any person refusing to give a report, without reasons, or giving r false report, or refusing to attend a hearing, or refusing to undergo a medical examination, in case such is demanded by the Insurance RefDree.in accordance with the provisions of Article ,83- 9, paragraph 1, shall be subject to a fine of not more than 5,000 . n. % Article 89. hJ.hen an employer who is charged with the establish- ment of a Health Insurance Society fails, without reason, to apply for' approval of the Society by the date sot by the Welfare Minister, he shall be subject to a fine of not more than twice the amount of con- tributions to be borne during the period of such delay in making appli* cation. Article 90, In case a Health Insurance Society or a Health Insur- ance Federation violates the order prescribed in Article 37 (including the cases when Article A2-2, paragraph 5, is applicable), refuses, or hinders the action of the Welfare Minister, the officials of the Society orFoderation shall be subject to a fine of not more than 5,000 Yen. Article 91. In case any representative of a juridical person, or any deputy or employee of, or any oth*'r person working for a juridical person or an individual, commits offenses in relation to the business of the said juridical person or individual, as mentioned in Article 87, paragraph 3 or paragraph 4, or in Articles 88 and 88-2, the fine provider for in the said article shall be imposed upon the juridical person or the individual concerned, in addition to the offenders being liable to punishment as provided for* .. ' • - ,, v’-: • 'T *n ' <• •?. sX v t ' : 1 , . ■’ ’ , • ■ . , wa o.? ‘.i-n • hi • a - - '.-h2r * -wo-' far 1 ■ ■ ii ■■ ■ 1. This Law shell, come into force from 1 August 19/8; however, the amended provisions of Artiele. 70- i nd- Article -70-2;;sha:ll. come- into effect from t$3. fisc&X year 19/8. ’.f *v , w -v- w - • 2, As tp~ the , person .who i& qualified. as insurer1, as. of the time tof h ”r operation ofthe ,present Law and- date of enforcement of the present- Law'--' and is designated to the No. 17 grade under f.,he:classified1 standard". ■ i’;-' remuneration prescribed in Article 3 of the Enforcement Ordinance (1926 Cabinet Order No* 2/3) he shall be, regarded a-s qualified p-S- an insured. on the date of the-operation of the present. Lav/ and as-a result he shall be subject'to Article 3, paragraph 3, of the Health. Insurance Law*,. • .. 3*r The'.existing Insurance f'eferees and Social Insurance Appeals . . Board and its officials at thd time of enforcement of this Law shall be- come the corresponding organ and officials provided by, the Law .and with the same legal personality. ' ’ ' ... INDEX BY ARTICLE OF THE HEALTH INSURANCE LAW ADVISOPY COUNCILS Govt. Managed Health Insura nee -22 Social Insurance Medical Care - Central 13-5 Local /3-5 ALLO' .'kNCES , Additional by society 69-3 Childbirth - . Dependent 59-A Insured 50, 57 Claims from private doctors LL-2 Continuation after disoualif ied 55 Dependents 59-2, 59-3, 59-4 Exclusions 57-2, 57-3, 60, 6l, 62, 63, 6/, 65 Funeral Dependent 59-3 Insured 49, 56 Income offsets 58, 59 In lieu of services 44 Maternity 51, 54 Medical examination required 65 National Health Insurance- organization as agency *59-5 Nursing - Dependent 59-4 * Insured 50-2 . Payment of 44, 66 Rights against 3rd party 67 Rights not transferrable 68 Sickness and injury 45, /6, 47, *• 54 Taxes not applicable 69 APPEALS. Appellant’s decease 83-13 Decision form 33-12 Decision in part 83-11 Evidence for 83-9 Expenses for travelling 83-9 Filing of 30, 81, 83-6 APPEALS. (Gont’d) Form of, written or oral S3-7 Hearing on 33-8 Jurisdictional transfer 83-6 Lawsuit on 84-2, 36 Proxy for appellant 83-10 Where made 80, 81, 83-6' Witnesses 83-9, 83-10 APPEALS BOARD Cabinet Order provision 86-2 Decisions of 83-11, 83-12 Establishment of 82 Members of 33, S3-2, 83-3 Procedures of 83-/, 83-5, 83-8 Receipt of appeals 81 Secrecy obligation 85 Witnesses for 83-9, 83-10 BENEFITS Additional by society 69-3 Childbirth to dependent 59-4 Continuation after disoualified 55 Cost of medical care in lieu of //. Dependents 59-2, 59-3, 59r4 Exclusions from 57-2, 60, 61, 62, 63, 6/, 65 Income offsets 58, 59 Insured’s selection of doctor\for 43-2 Medical examination for 65 National Health Insurance organization as agency for Nonr-taxable status 69 Payment of 66 Rights against 3rd party 67 Rights not transferrable 68 Sickness and injury 43 CONTRIBUTIONS Base for calculation 3 ’ Calculation 71, 71-2, 71-3, 71-4 Civil Code Regulations on 4, 5 Collection procedures 11, 11-2, 11- 3, 11-4 CONTRIBUTIONS (Contid) ;.w—•••— reductions from wages 78 Relicuency charges and demands 11 Document delivery reouire:-ents 11-4 ' • ' . Due date of 79, 79-2 - Employer-§.nd employee rates 72, 75 Employer responsibility and payment 77, 78, 79, .79-2 Individual participation 20 Insured’s 3, 71, '71-2> 71-3, 71-4, 72, 75-2 . . Precedence of 11-3 Rates, ecuality and exceptions 72 Refund rights on 4 COVERAGE • • Cessation.of ,18, 19,'21 Date effect! ve 17 Exclusions 12, 12-2, 12-3, 13-2, 57-2 • Industiral types subject 13 Individual 20 Persons insured 13 Voluntary 14, 15,:16, 28, 29 DEPENDENTS. ; ' ' . Allowances for 5G-2, 59-3,. 59-4 Amount fpr medical bare, allowed 59-2 Benefits to 59-2, 59-3, 59-4 Census registration of 7 Definition of 1 Disqualification of 69-2 DOCTORS, AND DENTISTS Appointment am1 resignation 43-3 Cancellation of appointments- 43-4 ' Guidance by advisory council,' 43-5 Obligations in service 43-4 Representation on councils end committees 43-5, 43-7 Service in private capacity. 44 ' 'EMPLOYER Contributions 75, 79 Deduction of employee contributions 77, 78 ' ;• ' Formation of society 28 Members- of society 27, 35 Penalties for 88, 89 . Reports on insured to insurer 8 Representation on councils, committees, and boards' 22, 43-5, 43-7, 83 . . Two or mor<= in society 28 FACILITIES Insurer's duty to provide 23, 37-2 Ordered by Welfare Ministry 37-2 Use by non-insured persons 23-2 FEIERAT ION OF SOCIET IES Formation and controls 23, 37-2 GOVERN!'®NT INSPECTIONS . ’ Insured’s affairs 9 Medical care records 9 Society affairs 37 GOVERNMENT MANAGEMENT Provisions for 22, 24, 71-4 GOVERN ENT SUBSIDY Administrative expense 70, 70-2 GOVERNOR Appointments to local Social Insur- ance-Medical Care Advisory Coun- cils 43-5 Appointments of insurance doctors .43-3 Authority from. Welfare Minister 10 Cancellation of appointments 43-4 Media, for appeals 83-6 HEARINGS Conduct of 33-8 Decisions on 83-11, 83-12 HEARINGS (Cont'd) Evidence requirements 83-9 Expenses for travelling 83-9• Proxy for appellant 83-10 Witnesses for 83-9, 83-10 INSURER PERSON Appeal recuirements 83-9, 83-10 Application for individual coverage 20 Contributions from 3, 71, 71-2, 71-3, 72, 75-2 Census registration of 7 Consent of, when reouired 1/, 19, 29 Dependents of 1, 59-2, 59-3, 59- 4 Disoualification of 18, 19, 21, 55, 57, 57-2, 57-3, 60, 61, 62, 63, 6/., 65 Exclusions from coverage 12, 12-2, 12- 13-2 Includes toose to be insured 30 Medical examination of 65 Membership in society 27 Penalties on 88-2, 88-3 Remuneration of 3 Reporting duty to insurer 8-2 Representation of on councils, committees, and boards 22, 13- 13-7, 83 Rights not transferable 68 Selection of doctors 43-2 Working for two or more employers 42 INSURER Calculation of medical care claims 43-6, 44-2 Coverage of multiple job employees 42 Facilities to non-insured persons 23-2 Payment of allowances and expenses 60 INSURE?. (Cont'd) Providing facilities to insured 23-2 Rights against 3rd parties 67, 69-: INSURANCE PEPEREE Appointment of 81-2 Receipt of appeals 83-6 Secrecy obligations 85 Subject to cabinet order 86-2 MEDICAL. FEES Controls on, private doctor's 44- 2 Ieteruination of amounts /3-6 Fees for service to non-insured 23-2 * MEDICAL FEE CALCULATING COMMITTEE Establishment and duty of /3-7 Welfare Minister concultation 43-6 MEDICAL CAPE ADVISORY COUNCILS Organization end formation of 43-5 HU NIC IPALITY Collection action and fee there- for 11-2 PUBLIC INTEREST Representation oh councils, commit- tees end boards 22. /3-5, 43-7, 83 PENALT IBS Contribution 11 Employer 88, 89 Federation 90 Foreclosure 11-2 Insured persons 88-2, 88-B Official r-relation 85- 8X 91 Society 90 PRESCRIPTION - - 7 •' v Civil code regulation A, 5 Contributions,- on .A REMUNERAT ION Base for contribution 3 Calculation and determination 3, 3-2 . Fefinitiorj of 2 Standard table for 3 SOCIETY Additional benefits 69-3 Approval requirements 32- 36 Articles requirement 32, 36 Composition of 27 Consent of members to form 29 Constribution rates for 71-/., 75, 75-2 Pissolution of 39, AO, A1 Facilities, order for 37-2 <,• Federation of AA-2 Formation compulsory 31, 32 Formation voluntary 28, 29 Juridical person status 26 Management, provisions for 25 Management by Welfare Minister 38, 39 Members of 35 Operations not subject to taxes 6 Penalties on 89, 90 Reports to Welfare Minister 37 Remuneration, fixing rights ‘2, 3-2 Welfare Miriistery controls 37 through A2 WELFARE MINISTRY Appointments to - Health Insurance Advisory Coun- cils 22 Medical Fee .Calculating Com- mittee A.3-7 Social Insurance Medical Care Advisory Council Y3-5 Appointment of insurance referee 81-2 WELFARE MINISTRY (Cont’d) Approval of society 1A., 29, 34, 36 Authority to foreclose 11-2 .Authority to prefectural governor 10 Change in contribution rates 71-A Control of society 37 thru A2 Computation of subsidy 70-2 Establishment of, appeals board 82 Fee determinations A3-6 Ordering facilities 37-2 Ordering formation of society 31, 32 Reports required ... 37 3A CABINET ORDER English Translation of the Japanese ENFORCEMENT REGULATIONS OF TIE HEALTH INSURANCE LAW (As established by Cabinet Order No 243, June 1926, and amended by Cabinet orders in 1927, 1929, 1934, 1938, 1940, 1941, 1942, 1944, 1945, 1946, June 1947, and August 1948)« 25 February 1949 Social Security Division PHW GHQ SCAR Incl 2 ENFORCEMENT PECULATIONS OF THE HEALTH INSURANCE LAW (As established by Cabinet Order No. 243, Juno .1926 and emended by .Cabinet Order in .August 1948), Chapter I. Go no re 1 Rules, Deleted 1/ Articles 1 through 8. Deleted. Chapter II, The Insured Person, Deleted, Articles 9 through 10-2, Deleted. Chapter III, Health Insurance Societies and . • Health Insurance Federations, ; , " - Y Section 1, Formation of a Society, Article 11. When the employers who desire to form a Health Insurance Society seek to obtain the consent of those insured, as provided in Article 29 of the Health Insurance Law, the employers must inform the insured employees subject to Article 29 of the Health In- surance Law and must also inform the employees to be insured as pro- vided by Article 30 of the Health Insurance Law, of the following matters:' 1, The number of and the typo of employment of those who are to become member of the Society, 2, The proposed organization of the Society, 3, The proposed, contribution rates, A. The proposed insurance benefits, 5* The proposed plan of operations. Article 12, In the Society’s articles the following matters sha11 be provided: 11, The title or name of the Society, 2, The location of the Society’s office, 3, The name and location of each working place, where the Society is to be in effect, 1/ Chapters I, II, IV, and V wore incorporated in their entirety in the basic Law* in July 1948. L, The method of publication to be user1 by the Society. 5. Other important matters Concerning the Society. Article 13. The Society shall use the phrase ”Health Insurance Society” in its title or name, An organization that is not a Health Insurance Society shall not use the phrase "Health Insurance Society” in its title or name, Article 1/,. The employer and employee contribution rates to be applied and an estimate of the income anc* expense of the Society for the first year of its operation shall be made by the employers seek- ing to form the Society and shall be submitted to the He If a re for approval. Article 15, "then the be If a re blinlster approves the f ormatlon of a Society he shall publish the following information; 1, The title or name of the Society, 2, The location of the office of the Society. 3, The name and location of the wording place where the Society shall be in effect. /. The date of approval. when the competent authority 1/ approves a change in a Society's articles with respect to iteis 1 or 2 mentioned above, he shall make s uc h c ha nge pub 1 ic . article 16. Then the,approval for forming a Society is obtained the employers of the Society shall publish without delay the articles of the Society, Article 17. Then the approval for forming a Society is obtained tke employers ■ shall convene the council of the Society without and shall report the status of the formation of the Society, the con- tribution rates to be used, the estimate of the income a nr* '«'n-ense for the first year of operation, end other io'ortant matters. Article 18, After the Society is formed and until the directors of the Society over their official duties the employers -shall exercise the duties of the directors. Section 2. The Council of the Society. l/ See Article 73. 2 Article 19* A Hoc. 1th Incurs nco Society shell form a Society G ounc11. The Society Council shall consist of a chairman a nr1 councillors. Article 20. A Society council shall have a fixed even nunber of councillors. One-half of the councillors shall bo appointed by the enployers from the employers, their deputies, or employees, and one- .. half shall be elected by a mutual vote of the Society no obeys from the insured members. Article 21, V/hon councillors assune their duties, or when they resign or die, the event shall be made public without delay. Article 22. Fcleted, Article 23» Alien a Society member cucstions the validity of the election of councillors or the vote of councillors who participated in the election he shall be remitted to file a. .protest with the directors of the 'Society within 7 days free the date of the publication specified in Article 21, '■Then a protest in files the directors shall submit it within 20 days to the council for a decision and when such decision is made it shall be published without delay, V/hen a protesting member is not satisfied with the decision made b the council he way appeal to the competent authority within 30 days fro the day of the council’s decision. In such case the Health Insurance Society shall be regarded as an authorized government office l/ provide* by the Appeal Law* Councillors shall not lose their right to attend the council meet- ings and to participate in council discussions while the' d c is ion men~ tionod in the second paragraph of this article is being rr,ade or while the decision on the appeal as mentioned in the preceding paragraph is being made, * ' * Article 24. In addition to the provisions of these enforcement regulations, matters of the Society c ncorning the fixed number, Quali- fication, term of office, and election of councillors shall be governed by the provisions of the articles prescribed by the Society, Article 25. Matters of the' Society upon which a Society council must make decisions shall bo as follows; 1, The preparation of estimates of income and expense, l/ The "welfare Minister or the prefecture! governor. 2. The prop?re t ion of reports on operations ?nd the settle- ment of accounts, 3. The assumption of obligat ions besides those provided in the estimates of income end expense, and the giving up of Society .rights. . ; ' 4. Xhe methods, to be employed In controlling reserve funds* $, The disposal of i reserve fund or other -important pro- perty, 6., The .negotiation of a-loan for the Society.- 7, A change in the articles of the Society*-. 8. The contribution rate's to bo used.; 9* The institution and settlement of appeals and law-suits, 10, Other important matters of the Society, Article 26,.-The Society council shall bo'able to inspect docu- ments concerning-the business of the Society, demand reports from its directors, examine the management of the business and the execution of decisions, and examine receipts and expenses. The Society council shall be able to appoint committees composed of councillors and roouire them to handle council matters. Article 27, The Society council shall be convened by the directors, When ■more than onothird of the fixed number of councillors roouest the convening of the council for the purpose of handling matters which are subject to. council action, the directors shall convene the council within seven days, - ■ • '• The convening of the council shall be made at least throe days before the opening day of sessions except when matters are- urgent and demand that the sessions start immediately. The Society shall be able to prescribe further rules with respect to the period mentioned for convening the council, V/hon the council is in session and urgent matters arise the direc- tors shall be able to submit such matters to the council immediately. The sessions of the council shall be opened and closed by the d irectors'. Article 28/ The chairman of the concil shall be appointed by the directors and he shall preside over the'council meetings, and maintain : order in the council room* Article 29, When less than half of the fixed number of council- lors are present, the council sessions shall not be opened; however, when the number is less t.han one-half because- of the exclusions pro- vided in Article 32 this rule, shall-not apply. Article 30. The decisions of the Society’s council shall be made . by a majority vote of the councillors present, and in case: ,of a tie ■; vote, the decrision shall be made by the-chairman. Article 31. Any changes made in the articles of a Society must be approved by more than three-fourths of the councillors present, - , Article 32, The chairmen and councillors shall not be permitted to participate in proceedings of the council that concern their own person- al affairs; however, when such persons obtain the consent of the council they shall be able to participate. Article 33. Each councillor shall attend the council sessions and vote. However, when a councillor, is not able to attend the council.. , • because, of illness or unavoidable circumstances he shall be. able to. vote by proxy through an entrusted councillor as provided in the- articles of the Society, In such event the absent councillor shall be regarded as having been present at the council, , ' / Article 3A. Members of the Society shall be able to hear council sessions except when ‘a special session, as provided in the Society's articles, precludes the members’ attendance,. . - ■ Article 35, A councillor shall be able to receive from the. Society his travelling foes reouired to carry out'his duties, * When a councillor who Is insured is denied, emolument from his 1 customary employment beet.use of his service as a councillor, he shall be able to obtain the said compensation from the Society/ , The travelling fees mentioned in the first- paragraph and the value and method of payment of the above mentioned compensation shall depend on what the articles of the Society provide, ‘ • 'Section 3. Officials of a Soc-iety. Article 36, A Society shall have directors, „ The fixed number of directors shall be even. One-haIf the number shall be elected by a mutual vote of the councillors who wore appointed by the employers, and .one-half, shall be electee’ by a mutual vote of the councillors who re.re electee' by the . insured members. One of the directors shall be the chief direct or and he shall be electee’’ by the directors who were, electee’ from the councillors appointee3 by the - employers* . , ‘ ’ ' ■ ’ Article 37. The chief director Shall represent the Society, When the chief director is not available because of unusual circumstances another d irector shall take his place in ac'.ordance with the articles of the Society. - , . Article 3B, The affairs of the Society shall be decided by a ‘ majority vote of the directors, except in a case covered by the articles of the Society. In case of a tie vote, the decision shall be mac’s by the chief director, , Article 39. When a Society council fails to organize or form —/> boss not decide the matters it should decide, or it is very difficult to convene, the directors of the Society shall be empowered under the direc- tion of the competent authority to dispose of the matters which the c ounc il should bee ide. Article AO, The birectors of. a Society shall be able to becibe arbitrarily the matters of the Society that are urgent anb demand imme- diate attention and which arise when there is not time to convene the council of the Society or when the council fails’to form 2/, or if the matter to be decided is insignificant. Article Al. When directors’dispose of matters in agreement with the provisions of the preceding. two articles, they shall report the action to the council at the next session of the Society's courfcil. Article Al-2, When a change of articles of the. Society is approved the directors shall without delay make the change public. Article A2, The directors shall provide the office of the Society with articles, an inventory of property, reports o.f business operations, a ledger of the Society's ’"embers, and records of the council. % When-members of. the Society recuest an inspection of the above mentioned documents, the’ directors shall not be able to refuse the inspection without good cause. Article A3. .The provisions of Article? 21, 2A, end 35, applying to councillors shall with eoual force be applicable to the directors and chief director of a Society, 1/ and. 2/ Applicable after the initial formation of the council and the election of the directors by the councillors. Section 4« Financial Affairs of a Society. .Article 44, The. fiscal year of r. Society shall bo the .same as that of the Government, Article 45. A Society shall mako an estimate of income and expense each fiscal year and shall obtain the approval of the estimate by the competent authority. When an estimate is corrected or changed, approv- al of such correction or change must be obtained from competent author.' tity, . The amount of money specified in each major section of. an estimate shall not be diverted to another section. The amount of money specified in each article of a section of an estimate may be diverted to another article of the same section by decision of tho Society council. Article £6, A Society shall be able to negotiate long term ex-' * penditures through decision of its councils Article 47. A Society shall provide an emergency fund to cover expenditures in excess of estimates, Tho use of tho emergency fund shall be limited by the articles of-- the Society. Article AS* A Society shell receive its revenue until May 31 of • the next fiscal year and pay its expenditures until April 15 of the next fiscal year before closing its revenue and expenditure accounts for a fiscal year. Article 49, A Society that desires to change its contribution rates must obtain tho approval of the competent authority before making such change. Article 50, A Society shall accumulate,.as a reserve fund, money which corresponds to 5 per cent of tho average annual sum (in case the surplus for the year docs not roach 5 per cent, then the total surplus for the year) of the past three years cost required to grant benefits tin case the past yerrs arc less than three, then the total of such past years), *- The reserve fund within tho scope mentioned above, shall not be used unless there is a deficiency in tho funds reeuired for insurance benefits• Article 51, Deleted, Article 52. Tho methods to be used in controlling the reserve fund and other properties shall be prescribed in tho articles of the Society, Article 53. In the event the Society runs, short of cash,money . for expenses, it shall be able to borrow temporarily the cash belonging bo the reserve funs' or obtain a temporary loan from others,* The money received according to the preceding provision as a tem- porary loan shall be repaid to the reserve fund or other creditor with- in the seme fiscal year, r -■ Article 5/'. When a Society obtains a long term loan, the method of application, the fixed interest rates, and- the. method of redemption ghall be decided and approved by competent authority, and any change in the said matters shall be decided and approved by competent authority-. Article 55. When the Society -proposes a disposition of its important properties it shall obtain the approval for such action from the competent authority. Section 5. Tivision, Combination, and rissolution of a- Society, Article 56, The combination or division of a Society shall re- pairs the consent- of a .majority of three-fourths of the concillors and he approval of the Welfare Minister, When any change in the articles of a Society is required, such be made in accordance with the provisions of the preceding paragraph. t :■ , f ' i-' . A-rticle .57, A division of a Society shall not be made' of a part of a working place when such part is within the working place where the Society is in force.. Article 58.. When a division of a Society -is to be made the number of....insured, members of the Society which,-; is to continue to exist after the. division or the number of members of■ the Society which comes into existence because of the division, shall not be less than three hundred. Article 59,. The a rt ic le s, contribution rates, €nd,the estimates of income anc expense for the first fiscal year of the Societv which comes into existence because of a combination shall be settled by the .ouncillois elected by each Pocioty and shall rocuire the approval of jhe Welfare Minister, . 60, .The articles, contribution rsto and the estimates income expanse for tho first fiscal year of the Society which into existence because of a division shall bo settled by the who are members of the Society and shall rocuire the approval if the Welfare Minister. Article 6l, A Society which continues to exist after a combina- tion, • or a. Society which comes into existence because of- a combination, shall take-over the assets and liabilities of the"Society which dis- continues becausQ-s of the oombination. ■ V . A Society which is formed by a division or which remains after a division shall take over or ..retain its respective part of the assets and- liabilities of the Society in which the:division, was ijiade. The limits of the assets and liabilities which shall be taken over by reasons of the preceding, provision shall.be decided concurrently with the decision of the. division and shall require the approval of the Welfare -Minister, ■ • v ■ r • s Article 62, When the Welfare Minister approves t he - c omb inat i on or division of a Society, ho shall make public the following matters con- cerning the Society which comes into existence or discontinues because of the- combination or the division and the. Society which, continues to exist after the combination or division. 1, The title or name of the Society.-, .. 2, The locality of the office of the Society, 3% The nrmo' and location of the place where the Society is . established, . . 4, The date of approval, , , • : Article 63• The provisions of Articles 16 through. 18 shall bo applied mutatis mutandis to the Society which comes into existence through a combinatinn or division, r When the directors of a Society which is combined or divided are members of the Society which came into existence because- -of the combi- nation or division, they shall exqraise the-duties of the employers as prescribed in the preceding paragraph. Article 64, The dissolution of p Society shall be decided by the. council of the Society and shall require the consent of three-fourths -of the- fixed number of councillors and the approyal of-the .Welfare Minister,. - .. ■ . ■ - . . ’ • . * •- •• * -• : • • . ■ 1 ■■ ■ ■ Article 65, Although a Society may have no insured members it will 'not. be dissolved if the absence of insured members is temporary. Article.66, 7/hen a Society is dieselv-d t-ho .Welfare Minister shall make public the dissolution according .to the example stated in Article 62, ■; ; ■ ; : ' -a o .-m, * • Article 67, When the number of working places of a Society is in- creased or decreased the consent of the employers who are to be included or eliminated and the consent of half or more of the insured or insurable employees 'Shall be required. When the working places which are to be included or eliminated are two* or more in number, the consent of the insured and insurable above prescribed shall be required for each working place. The Insured prescribed in the pieceding two paragraphs shall bo those to be insured in case the application for the approval of the change of articles concerning the including of the working places is made concurrently with the application for the approval prescribed in Article 14., paragraph 1, of the Health Insurance Law, Article 68. The provisions of Article 57 shall be applied with necessary modifications concurrently with the preceding article. Article 69, When a working place is to be eliminated, the number of insured members remaining in tho Society shall not be less than three hundred, • Article 70, When a Society is subject to receive tho consent pre- scribed in Article 67, the persons who ar" to receive or lose membership in the Society because of tho inclusion or the elimination of a working place in which they aro employed shall bo advised as follows: those to receive membership shall be notified of fhe matters stated in each item of Article 11, and those to lose membership shall bo notified of the reasons for the elimination of their working place. Section 6, Supervision of the Society, Article 71. Competent authorities shall be able to- order the dis- solution of a Society* s council,^ When a Society!s council dissolves an election of new councillors shall be made within one month. Article 72, Those persons who are released from their offices under the provisions of Article 39 of the Health Insurance Law shall not oe able to officials of a Society for two years. Article 73, The ’’competent authority” as prescribed in Article 15, paragraph 2; Article 23, paragraph 3; Article 39; Article A5f paragraoh 1; Articles A9, 5A, end 55; and Article 71, paragraph 1, shall bo the Welfare Minister in case of the approval concerning the combination or division of a Society or in case the Society covers two or more prefectures; and in other cases’ "it shall be the prefecture.! governor 'has authority over the locality whore the chief office of the Society iSrlocatod, V’ rr- Sect 1 bn:-7;.; Federation- of Health Insurance Societies, V- ’ •‘Article 73-2. In tiie: articles of of Health Insurance Societies- (hereinafter referred, to as ’’Federation”) the following matters shall be stated; 1, The purpose and plan of the Federation. 2, The title or,name of the Federation. 3, The' location of the office of the Federation, A. Matters concerning joining- .or withdrawing from the Federation. 5« Matters concerning assets and liabilities, 6, The method of notification to be employed., • ' 7. Other important matters concerning the Federation, Article 73-3. A Federation shall use the phrase ’’Federation of Health Insurance Societies” in its title or name, ... An organization which is not a Federation of Health Insurance Societies shall not use the phrase ”Federation of Health Insurance Societies” in its title or name,- •- ° Article 73-A, An estimate of the income and expense for the first fiscal year of the Federation shall be decided by the Societies which are to establish the Federation and it shall be approved- by the Welfare Minister, * p Application for approval; as provided in the preceding- paragraph shall be mads concurrently ’with the application for approval of forma- tion-of the Federation, : • ; ' a- Article 73-5* The cost required to establish a Federation shall be borne *by the Federation, • . , . "Article 73-6. A Federation shall havo general meetings and a‘v- prosident, vice-president, and directors, p ■ • . , _ . ■ ■ ■ \ - General meetings shall be held by a chairman 1/ a»d g-neral meeting members. The g :noral meeting members shall be elected by a mutual vote of the chief directors of the Societies forming the Federation, However, mem- bers of a general meeting who make decisions concerning the dissolution of the Federation according to the provisions of Article 67, applied with necessary modifications, or by the provisions of Article 73-9, shall be appointed by the chief directors of the Societies forming th3 Federation, The president of the Federation shall be elected by a mutual vote of the directors of the Federal ion. Besides those matters which are provided in these regulations, the matters pertaining to, the organization and powers of the general mooting; the fixed number, Qualification, term and election of members of the meeting; the fixed number, qualification, term, election, and powers of the president, vice-president, and directors of the Federation shall bo decided by articles of the Federation. Article 73-7, A Federation shall bo regarded as exist put within fho scope ®f the object of liruidation, even if it dissolves. Article ■' 73-8, When a Federation dissolves, the Federation directors shall become the liquidators, In.the. event there ar; no directors available to serve as liqui- dators, according to the preceding provision, the Welfare Minister shall appoint liquidators. When liouidators fail or cannot perform their du- ties, tho Welfare Minister shall appoint liouidators. ♦ Liouidators shall r present tho Federation and have powers to ex- ercise every action reouirod to effect liquidation. With respect to the method employed in 'licmidation and disposal of Federation properties, tho liauidetors shall obtr in the approval of tho WeIfare Minister. When tho Welfare Minister considers it necessary he shall be able t*o order a change in the method of ■ liruidation and disposal of 'proper- ties, or he may re leas'- the liouidators from their offices. Action 73-9, The provisions of Articles 15; 16; 21; 25 through 33; 37 through 72; 77 through 78; 57; 55; 67; 71, paragraph*1; and 72 shall be applied with necessary modifications to Federations; however, the employers referred to in Article 16 shall b chang'd to directors, and 1/ No provision is made for the c:lection or appointment of the Chairman other than the general provision for handling Mother matters” as stipulated in Article 73-6, paragraph 5. the compet nt authoriti s mentioned in Articles 39; /5, paragraph 1; 57; 55; and 71, paragraph 1, shall be changed to Welfare Minister. Article 73-10. The provisions of Article 21 shall be applied with necessary modifications to the president, vice-prosident, and rMroc- tors of a Federation. Article 73-11. In addition to the matters provided in these regu- lations, other necessary matters concerning the Federation shall bo decided by Ministerial Orditrnce. Chapter IV. Insurance Benefits, Tdiet'd, l/ Articles 7/ through 89. Deleted. Chapter V, Liability. Deleted, 1/ Articles 90 through 101-2. relot?d. 1/ Chapters IV and V -nre incorporat d in their ntirety in the basic Law in July 19A8, 13 QUITE FOP A REVIEW OF k SOCIETY AT MINISTER TNG MH INSURANCE ( Fenko Hoken) 1, Identity of Society - a) Name; . b) Location:. c) rate of Formation; . . d) Predecessor: . e) federation name, if member: 2, Coverage Tata - a) Number of insurer1 members; Male. _, Female Total b) Number of dependents: Male ___ , Female Total ■ c) Number of employers'; . d) Number of establishments; e) Types of industry or industries covered; . 3, Administrative Bodies - a) C ounc illors; Number in Office Representing employer: Representing employees; b) Tirectors; Number in Office Re pre se nt ing e mpioye r: Representing employees , Services and Allowances - a) Indicate services provided: medical examination. , , appliances , medical treatment , surgical ooe.ration , medical attendance , hospitalization , clinical service , dental service , nursing service__ , transportation , ot he r (s re c if y); _ . _ _ b) Indicate allowances provided; maternity nursing , delivery , funeral _, medical treatment , sickness and injury_ , family treatment sxpense_ , other (specify); 5* Facilities, .Personnel, and Service Tata - a) Enter the number of facilities available according to type; hospitals , clinics_. , other (specify): y b) Enter hospital capacity for medical care; in- pa t ie nt s , out - pat is nt s c) What dental facilities are provided? d) What facilities are provided for TB patients? e) Enter number of full-time staff personnel: , nurses , dentists , pharmacists , c Is rks , ct he r , T ot a 1 , f) What percent of the service is c nducted by full-time doctors? , % Incl. No. 3 g) What percent of the service is conducted by insurance doctors? _ % . V h) What percent of the service during the past fiscal year r/as given to the insured members? %, to their dependents? % 6* Financial Affairs and Operations - a) 'Contributions: enter, employer rate employee rate %9 and average amount per employee’ for the last fiscal year ¥, b) Enter the total income received during preceding fiscal year ¥, and the., per cent of such total received from employer constitutions %, employee contributions _ %, government subsidy %, other sources % c) Enter the total expense for the preceding fiscal year ¥, and the per cent of such total expended for medical benefit Jfif temporary disability benefit , burial expense %, delivery expense %, maternity care %y child birth allowance %y family medical ex- pense fa, family burial expense %, wifes delivery expense f>9 other benefits %, welfare service jo, administration %, other d) What percent of the benefits granted during the preceding fiscal year were paid in cash? _ %. e) Enter the amount of assets ¥, liabilities ¥, and reserve account ¥ of the society at tne end of preced- ing fiscal year* f) Give last date of periodic audit of society: g) Who conducted the audit? h) Have monthly reports been submitted promptly? 7. Payment of Medical Services - a) What is the amount allowed per modicrl fee point? ¥ b) Does the society utilize the facilities of the Medical Fee Pay- ment Fund in the payment of claims? . How much does the * society owe the Fund? ¥, c) How much is the monthly salary, including cash allowances, of full-time doct©rs? and nurses? employed by the society. d) What other remuneration, if any, is received by full-time doctors? , nurses?’ : 8. Complaints - a) Enter the major typos of complaints received from members regard- ing, benefits, allowances,, contributions, or other issues: b) How many complaints are received during an average month? 2 9. Informr.tionf 1 Service - a) Are copies of the Lev;, ordinances, regulations, and rules made available to the mombcrs?_ b) VJhat other methods are used by the society to give information on appeals and benefit rights to the members and their h dependents? 10. Contact Information - a) Tate of Contact; b) Persons contacted and their titles: c) Have previous contacts been made vith this society? , If so, give d: t s end pertinent observations; d) Present contact m;de by: PcteT ' I ~ REMARKS; 3